Method and apparatus for guiding a suture thread

ABSTRACT

A suture device is configured to guide a suture thread. The device includes a sleeve that defines an opening, and a plunger to which a suture thread can be attached. The plunger can be inserted into the opening of the sleeve, and movable between a retracted position and an advanced position. When the plunger is in the retracted position, a distal portion of the suture thread is located proximal with respect to the distal end of the suture device. When the plunger is in the advanced position, the distal portion of the suture thread is driven out the distal end of the suture device.

CROSS-REFERENCE TO RELATED APPLICATIONS

This claims the benefit of U.S. Patent Application Ser. No. 61/392,601filed Oct. 13, 2010, the disclosure of which is hereby incorporated byreference as if set forth in its entirety herein.

FIELD OF THE DISCLOSURE

The present disclosure relates generally to a surgical device, and inparticular relates to a suture device configured to guide a suturethread during a surgical treatment of human tissue.

BACKGROUND

One problem associated with conventional suture devices is that theinsertion of the suture thread into the eye in the needle can becumbersome and time consuming for the operator. Another problem withconventional suture devices is that they cannot handle both monofilamentand braided suture in one instrument. This means that during a procedurean operator may have to switch between instruments in an inefficient andtime consuming manner and also follow a complicated proceduresimplification.

SUMMARY

In accordance with one embodiment, a suture device is configured toguide a suture thread. The suture device includes a sleeve and aplunger. The sleeve includes a sleeve body that defines a proximal end,and a distal end spaced from the proximal end along a central axis. Thesleeve defines an opening that extends along the central axis betweenthe proximal end and the distal end. The plunger includes a plunger bodythat extends along the central axis when the plunger is disposed in theopening of the sleeve. The plunger defines a clamp, the clamp includinga pair of surfaces that are configured to capture the suture thread soas to releasably attach the suture thread to the plunger. The plunger isslidably disposed in the opening of the sleeve and movable distally froma first retracted position in which a distal portion of the suturethread is located in the suture device to a second advanced position inwhich the distal portion of the suture thread extends out of the suturedevice.

DESCRIPTION OF THE DRAWINGS

The foregoing summary, as well as the following detailed description ofan example embodiment of the application, will be better understood whenread in conjunction with the appended drawings, in which there is shownin the drawings an example embodiment for the purposes of illustration.It should be understood, however, that the application is not limited tothe precise arrangements and instrumentalities shown. In the drawings:

FIG. 1 is a sectional perspective view of a suture device constructed inaccordance with one embodiment, showing the suture device in a firstretracted configuration;

FIG. 2A is a sectional side elevation view of the suture deviceillustrated in FIG. 1;

FIG. 2B is a sectional side elevation view of the suture deviceillustrated in FIG. 2A, but shown in a second advanced configuration.

FIG. 3 is an enlarged sectional side elevation view of the suture deviceillustrated in FIG. 2 and taken along line 3-3;

FIG. 4A is a sectional end view of the suture device illustrated in FIG.3 and taken along line 4A-4A;

FIG. 4B is a sectional end view similar to FIG. 4A, but constructed inaccordance with an alternative embodiment;

FIG. 5 is an enlarged perspective view of a proximal end of the suturedevice illustrated in FIG. 1, showing a plunger; and

FIG. 6A is an enlarged perspective view of a distal end of the suturedevice illustrated in FIG. 1, showing the suture device in a secondadvanced configuration; and

FIG. 6B is an enlarged perspective view of the distal end of the suturedevice illustrated in FIG. 1 constructed in accordance with analternative embodiment.

DETAILED DESCRIPTION

Referring to FIGS. 1-2A, a tissue repair assembly 18 includes a suturedevice 20 and at least one suture thread 24 that is configured to bereleasably fixed to the suture device 20, for instance whenapproximating soft tissue of a patient. The suture device 20 defines aproximal end 27 and a distal end 29 that is opposite the proximal end27. It should be appreciated that the terms “proximal” and “distal” andderivatives thereof used with respect to the suture device refer to adirection from the distal end 29 toward the proximal end 27, and adirection from the proximal end 27 toward the distal end 29,respectively.

The suture device 20 generally includes a sleeve 22 that extendssubstantially along a central axis 23, at least a portion of which canextend along a longitudinal direction L, or can extend along anysuitable alternative direction as desired. It should be appreciated thatthe term “longitudinal” and derivatives thereof refer to a directionalong or parallel to the longitudinal direction L. The terms “radial,”“transverse,” and derivatives thereof refer to a direction substantiallyperpendicular to the central axis 23. The sleeve 22 includes a sleevebody 25 that defines a proximal end 26 and an opposed distal end 28 thatis spaced from the proximal end along the central axis 23. Similarly,the suture device 20 defines a proximal end 27 and a distal end 29opposite the proximal end 27. The sleeve 22 further defines a centralopening 30 that extends substantially longitudinally through the sleevebody 25 from the proximal end 26 to the distal end 28. The opening 30can be cylindrical or any can define suitable alternative shape asdesired. The suture thread 24 can be a multifilament or a braidedstructure, or any alternatively constructed thread.

The suture device 20 includes an actuation assembly 31 that can bedisposed at the proximal end 27 of the device 20, and can furtherinclude a tip end 35 that can be disposed at the distal end 29 of thesuture device 20. Thus, the actuation assembly 31 is disposed proximalwith respect to the tip end 35. The tip end 35 can define a cannulatedhook 36 that, in turn, can define a distal tip 68 that facilitatesmovement of the hook 36 through a body tissue wall of a patient and intoa body cavity. The distal tip 68 can be acuminate or alternativelyshaped as desired. The cannulated hook 36 can be curved in a plane thatcontains the central axis 23 so that the hook 36 can be passed around adesired body portion of a patient when passing the hook through thetissue.

Referring also to FIG. 5, the actuation assembly 31 can include anactuator 33 and a handle assembly 45. The actuator 33 can include apushbutton 56 and a plunger 32, and is operable to advance a distal end38 of the suture thread 24 from a location recessed with respect to thedistal tip 68, and thus recessed in the suture device 20, to a locationthat is out, for instance distal, of the suture device 20. Thus, it canbe said that the suture device 20 is operable from a first retractedconfiguration and a second advanced configuration that causes the suturethread 24 to likewise translate between a first retracted position(FIGS. 1-2A) and a second advanced position (FIGS. 2B and 6A-B) that isdistal with respect to the first retracted position. For instance, thefirst retracted position of the suture thread 24 can be recessed withrespect to the distal tip 68, and the second advanced position can bedistal with respect to the distal tip 68. Alternatively, the firstretracted position of the suture thread 24 can be distal with respect tothe distal tip 68, and the second advanced position can be disposedfurther distal with respect to the distal tip 68 than the firstretracted position. Thus, the distal end 38 of the suture thread 24moves distally from the first retracted position to the second advancedposition. The handle assembly 45 includes a handle 46 that is configuredto be fixedly connected to the sleeve 22, for instance at the proximalend 26, and a fastener 48 that is configured to removably connect thehandle 46 to the sleeve 22. Accordingly, the handle 46 is configured asa brace that stabilizes the sleeve 22 as a distal actuation force isapplied to the actuator 33, such that distal translation of the actuator33 causes the suture device 20 to actuate from the first retractedconfiguration to the second advanced configuration. For instance, a usercan grip the handle 46 while simultaneously applying the distalactuation force to the actuator 33, such that the actuator 33 canadvance distally with respect to the handle 46. The actuator canlikewise receive a proximally directed force that causes the actuator 33to translate proximally, thereby causing the suture device 20 to iteratefrom the second advanced configuration to the first retractedconfiguration. It can thus be said that the suture device 20 isconfigured to iterated between the first retracted configuration and thesecond advanced configuration.

The handle 46 includes a stem 47 and a grip 49 that extendslongitudinally proximal from, and laterally out from, the proximal endof the stem 47. Thus, the step 47 extends distal from the grip 49. Thehandle 46 can be substantially T-shaped as illustrated, or canalternatively define any suitable shape as desired. The handle 46defines an aperture 52 that extends longitudinally through the stem 47and the grip 49 at a location in alignment with the central opening 30of the sleeve 22.

The handle 46, and in particular the stem 47, can define a stop memberillustrated as a neck 43 that divides the aperture 52 into a first orproximal channel 52A and a second or distal channel 52B. The neck 43further defines a necked aperture portion 52C of the aperture that isdisposed between the proximal and distal channels 52A and 52B, anddefines a cross-sectional dimension or diameter less that that of theproximal and distal channels 52A and 52B. In this regard, while variousstructure can be described herein as defining a diameter, it should beappreciated that the diameter can alternatively be referred to as across-sectional dimension, for instance that is not circular. The firstchannel 52A is configured to receive or otherwise retain the distal endof the push button 56, and the second channel 52B is configured toreceive or otherwise retain the proximal end 26 of the sleeve 22. Theneck 43 defines a first proximal abutment surface 43A, and a seconddistal abutment surface 43B.

The fastener 48 is illustrated as a traveler that can be configured as anut 72 that is threadedly mated with the distal end of the stem 47.Thus, rotation of the nut 72 relative to the stem 47 in a firstdirection can cause the nut 72 to travel, or translate, proximally alongthe stem 47. The stem 47 defines a chuck 70 having a ramped surface thatabuts a complementary ramped surface of the nut 72. Accordingly, as thenut 72 advances proximally along the distal end of the stem 47, theramped surfaces of the nut 72 biases the ramped surface of the stem 47against the sleeve 22, thereby creating a friction fit that fixes thestem 47 to the sleeve 22, thereby removably connecting the handle 46onto the sleeve 22. For instance, rotation of the nut 72 relative to thestem 47 in a second direction opposite the first direction can cause thenut 72 to travel, or translate, distally along the stem 47, which causesthe ramped surface of the nut 72 to be removed from the complementaryramped surface of the stem 47, thereby removing the friction fit of thestep 47 and the sleeve 22. The handle 46 can then be removed from thesleeve 22. It should be appreciated that the handle 46 can be connectedto the sleeve in accordance with any suitable alternative embodiment.For instance, the handle 46 can be integral with the sleeve 22.

With continuing reference to FIGS. 1, 2, and 5, the actuator 33 includesa pushbutton 56 and a plunger 32 that is connected, either integrally ordiscreetly, to the pushbutton 56. In accordance with the illustratedembodiment, the pushbutton 56 defines a grip 53 and a slider 50 thatextends distally from the grip. The grip 53 defines a transversediameter greater than that of the slider 50, and the slider 50 isconfigured to be slidably received in the first channel 52A of thehandle 46. The distal end of the slider 50 can abut the first abutmentsurface 43A of the stop member 43 to limit the distal travel of theplunger actuator 33 relative to the handle 45 and sleeve 22.Additionally or alternatively, abutment between the distal end of theactuator grip 53 and the proximal end of the handle grip 49 can limitthe distal travel of the plunger actuator 33 relative to the handle 45and sleeve 22. The pushbutton 56 defines an aperture 51 that extendslongitudinally through the grip 53 and the slider 50, in alignment withthe aperture 52 of the handle 46 and thus also in alignment with theopening 30 of the sleeve 22.

Referring now to FIGS. 1-4A, the plunger 32 includes a plunger body 57that defines a distal end 42 and a longitudinally opposed proximal end44. The plunger body 57 has an outer diameter smaller than that of theslider 50, such that the plunger 32 is configured to extendlongitudinally through the first channel 52A, the necked channel 52B,and the second channel 52C. The plunger 32 is further sized to beslidably received in the opening 30 in the sleeve 22. The plunger 32defines a channel 40 that extends longitudinally along the entire lengthof the plunger body 57, between the distal and proximal ends 42 and 44,respectively. The channel 40 can be substantially U-shaped incross-section, substantially V-shaped in cross-section, and thus cantaper curvedly, conically, nonlinearly, or in any alternative suitableshape from the outer perimeter of the plunger body 57 along a directiontoward the central axis 23, such that the channel 40 is configured toreceive the suture thread 24.

In accordance with one embodiment, the plunger 32 defines a clamp 34that is configured to releasably secure the suture thread 32 to theplunger body 57. In particular, the clamp 34 includes a section 41 ofthe channel 40 that can define a portion up to all of the channel 40. Inaccordance with the illustrated embodiment, the section 41 of thechannel 40 is disposed proximate to the distal end 42 of the plungerbody 57. It should be appreciated that the channel 40 can include morethan one clamps 34, for instance proximate to the distal end 42, theproximal end 44, and/or at a location between the distal and proximalends 42 and 44. The narrowed section 41 of the channel 40 can besubstantially V-shaped or substantially U-shaped in cross-section, andthus can taper conically from the outer perimeter of the plunger body 57towards the central axis 23 so as to define a transverse gap that isless than the cross-sectional dimension of the suture thread 24, so asto releasably retain the suture thread 24.

In accordance with the illustrated embodiment, the clamp 34 includes apair of opposed side surfaces 54 of the plunger body 57 that define thenarrowed section 41 of the channel 40. The side surfaces 54 extendrelative to each other and taper toward each other along a directionsubstantially transverse to the central axis 23. For instance, the sidesurfaces are tapered toward each other along a direction from the outerperimeter of the plunger body 57 toward the central axis 23 so as todefine a gap between the side surfaces 54 that narrows along a directionfrom the outer perimeter of the plunger body 57 toward the central axis23. Thus, the side surfaces define an angle α sufficient to cause thesuture thread 24 to be wedged by the plunger body 57 in the narrowedsection 41 of the channel 40, for instance between the side surfaces 54.For instance, the side surfaces 54 define a transverse dimensiontherebetween that is less than that of the suture thread 24.Accordingly, the suture thread 24 can be quickly and easily releasablyattached to the plunger 32 by imparting a force onto the suture thread24 that causes the suture thread 24 to move radially inward at thenarrowed section 41 of the channel 40. For instance, the suture thread24 can be inserted into the narrowed section 41 of the channel 40 alongthe transverse direction, which causes the side surfaces 54 to compressthe suture thread 24, thereby capturing the suture thread 24 in theplunger body 57 between the side surfaces 54. The suture thread 24 canlikewise be released from the clamp 34 in an easy and quick manner byapplying a transverse outward force to the suture thread 24 thatdislodges the suture thread 24 from the clamp 34.

The side surfaces 54 can be smooth, or textured so as to assist inretention of the suture thread 24. The angle α can be within a rangehaving an upper end as desired, including approximately 50°, or moreparticularly approximately 40°, and a lower end greater than 0°, forinstance greater than approximately 20°, such as greater thanapproximately 30°. It should thus be appreciated that the narrowedsection 41 can be configured to wedge suture threads of differentdiameters.

In accordance with an alternative embodiment shown in FIG. 4B, the clamp34 is elastically configured so that the suture thread 24 is clippedinto the plunger 32. For instance, the suture thread 24 can becompressed as it is inserted into the clamp 34, and the compression canbe reduced or eliminated once the suture thread 24 is fully received inthe clamp 34. For instance, the opposed side surfaces 54 of the clamp 34can taper away from each other along a direction substantiallytransverse to the central axis 23. For instance, the side surfaces 54taper away from each other along a direction from the outer perimeter ofthe plunger body 57 toward the central axis 23. In accordance with oneembodiment, the tapered side surfaces 54 can define elastic tongues 80and 81 that are configured to flex away from each other as the suturethread 24 is inserted into the gap disposed between the side surfaces 54along a radially inward direction from the outer perimeter of theplunger body 57 toward the central axis 23. Thus, the side surfaces 54illustrated in FIG. 4B are configured to capture the suture thread 24 inthe plunger body 57.

Alternatively still, it should be appreciated that the side surfaces 54can extend substantially parallel to each other, such that the gapdefined between the side surfaces the is sized less than across-sectional dimension of the suture thread 24 such that the opposedwalls 54 compress the suture thread 24 when the suture thread 24 isdisposed in the gap. Thus, it should be appreciated that at least aportion up to all of the gap defined between the opposed side surfaces54 is sized less than a cross-sectional dimension of the suture thread24 such that the opposed walls 54 compress the suture thread 24 when thesuture thread 24 is disposed in the gap.

Referring again to FIGS. 1-2, the device 20 can include a cannulatedhook 36 that extends from the distal end 28 of the sleeve 22. The hook36 can be press-fit into the sleeve 22, overmolded by the sleeve 22, orotherwise attached to the sleeve 22 as desired. For instance, the hook36 can be integral with the sleeve 22. The cannulation of the hook 36 isaligned with the opening 30 of the sleeve 22, such that when the suturethread 24 is attached to the plunger 32, the suture thread 24 can bepassed from the opening 30 in the sleeve 22 into and through thecannulated hook 36. In particular, the plunger 32 can translate distallywithin the opening 30 of the sleeve 22 toward the hook 36. In accordancewith one embodiment, the plunger 32 is inserted into the cannulation ofthe hook 36 when the actuator 33 is biased distally from a firstretracted position to a second advanced position, thereby actuating thesuture device 20 from the first retracted configuration to the secondadvanced configuration. When the plunger 32 is in the first retractedposition, the distal end 38 of the suture thread 24 can be recessedfrom, or disposed proximate with respect to, the distal tip 68 of thehook 36. For instance, the distal end 38 of the suture thread 24 can bedisposed proximal with respect to the distal end of the sleeve 22 whenthe suture device 20 is in the first retracted configuration. When theplunger 32 is biased to the second advanced position, the clamp 34carries the suture thread 24, and thus causes the suture thread 24 totranslate distally to a location whereby the distal end 38 of the suturethread 24 extends out the device 20. For instance, if the device 20includes the hook 36, the distal end 38 extends from the hook 36 out thesuture device 20. If the device does not include a hook 36, then thedistal end 38 extends distally from the sleeve 22 out the suture device20.

Referring now also to FIGS. 6A-B, the cannulated hook 36 can be curvedin more than one plane, such as two planes. For instance, in accordancewith the illustrated embodiment, the cannulated hook 36 has a firstcurved section 58 and a second curved section 60, along a central axis62 of the cannulated hook 36, which can be coincident with the centralaxis 23 of the suture device 20. In accordance with the illustratedembodiment, the first curved section 58 lies in a first plane and thesecond curved section 60 lies in a second plane that is angularly offsetwith respect to the first plane. The first plane contains thelongitudinally extending portion of the central axis 23 of the device 20and the central axis 62 of the cannulated hook 36. The second plane isangled to the first plane in such a way that the common line of thefirst and second planes extends orthogonally to the longitudinaldirection L. Thus, the hook 36 can be helically curved, which can beadvantageous when performing shoulder surgery, in particular surgery onthe rotator cuff or the meniscus, where limited anatomical space isavailable to move the tip end 35 of the device 20.

As described above, the slider 50 is connected to the proximal end 44 ofthe plunger 32 and has a greater diameter than the plunger 32. Theplunger 32 can be slim, and can have an outer cross-sectional dimensionsmaller than that of the opening 30 of the sleeve 22. The slider 50 fitssnugly in the proximal channel 52A defined by the aperture 52 of thehandle 46. Thus the handle 46, and in particular the aperture 52 definesa guide member that causes the slider 50, and thus the plunger 23, totranslate along the central axis 23. Alternatively, the outercross-sectional dimension of the plunger 23 can be substantially equalto that of the opening 30 of the sleeve 22. Further, the slider 50comprises a push button 56 arranged at its rearward end so that theactuation assembly 31 has a syringe like design that provide anergonomically friendly actuator for the user. For instance, the user canbrace two fingers under the grip 49 of the handle 46, and depress thepushbutton 56 by applying a distal biasing force to the grip 53 of thepushbutton 56 with his or her thumb.

During operation, the suture thread 24 is affixed to the plunger 32, forinstance by capturing the suture thread 24 in the clamp 34 in the mannerdescribed above, and the plunger 32 is inserted longitudinally into theopening 30 of the sleeve 22. Thus, the actuator 33, and also the plunger32 which is attached to the actuator 33, is in a first retractedposition. When the plunger 32 is in the first retracted position, thedistal end 38 of the suture 24 does not extend out the device 20 inaccordance with one embodiment. For instance, when the plunger 32 is inthe first retracted position, the distal end 38 of the suture thread 24can be disposed in the sleeve, and can reach the distal end 28 of thesleeve 22, or can alternatively extend into the cannulated hook 36.

The cannulated hook 36 can then be guided to a desired position within abody portion of a patient until the tip 68 of the hook 36 is in adesired position, such as a cavity within the patient's body. The cavitycan be a natural anatomical cavity, or can be created through theretraction of tissue. Next, the plunger 32, and thus also the actuator33, is advanced distally from the first retracted position to the secondadvanced configuration, for instance until the slider 50 abuts theproximal abutment surface 43A of the neck 43. As illustrated in FIG. 6A,the plunger 32 can extend into the cannulation of the hook 36 when theactuator 33 and the plunger 32 are in the respective second advancedpositions. It should be appreciated that the plunger 32 can be disposedproximal with respect to the cannulated hook 36 when the actuator 33 andthe plunger 32 are in the respective first retracted positions, oralternatively the plunger 32 can be extend into the cannulation of thecannulated hook 36 when the actuator 33 and the plunger 32 are in therespective first retracted positions, and the plunger 32 can extendfurther into the cannulation of the cannulated hook 26 when in thesecond advanced position.

Alternatively still, as illustrated in FIG. 6B, the plunger 32 canterminate at a location proximal with respect to the cannulation of thehook 36 when the actuator 33 and the plunger 32 are in the respectivesecond advanced configurations. Whether the plunger 32 is disposed inthe cannulation of the hook 36 or is disposed proximal of the hook 36when the plunger 32 is in the second advanced configuration, the suturethread 24 is guided such that the distal end 38 is translated out thedevice 20 as the plunger 32 is actuated from the first retractedposition to the second advanced position. For instance, the distal end36 of the suture strand 24 can extend distally out the sleeve 22, and inaccordance with one embodiment can extend distally out the cannulatedhook 36 when the plunger 32, and thus the suture thread 24, advancesfrom the first retracted position to the second advanced position.

In accordance with one embodiment, the distal end 38 of the suturethread 24 can protrude any distance out the suture device 20 as desired,for instance between approximately 1 cm and 2 cm out the device 20.Thus, the distal end 38 of the suture thread 24 can be grasped byanother instrument, such as a clamp, and the suturing procedure can becompleted. Thus, the suture device 20 can pass the suture thread 24through soft tissue of a patient and subsequently insert the distal end38 into a target location, such as a cavity within a patient's body, ina quick and easy manner.

Accordingly, a method is provided for inserting the suture thread 24into a body portion of a patient using the suture device 20. The methodincludes the step of attaching the suture thread 24 to the plunger 32such that a distal end 38 of the suture thread 32 protrudes from thedistal end of the plunger 32. The plunger 32 is placed in the opening 30of the sleeve 22 in a first retracted position, whereby the distal end38 of the suture thread 32 can be disposed proximal of the distal tip 68of the hook 36. For instance, the distal end 38 of the suture thread 32can be disposed in the cannulation of the hook 36 or can be disposed inthe opening 30 of the sleeve 22, for instance at the distal end 28, whenthe plunger 32 is in the first retracted position. The plunger 32 canthen be depressed distally, for instance by applying a manual biasingforce onto the push button 56, thereby advancing the plunger 32 from thefirst retracted position to a second advanced position, which causes theplunger 32 to eject the distal end 38 of the suture thread 24 distallyout the device 20. For instance, the distal end of the plunger body 57can extend to a location in the cannulation of the hook 36, or to alocation proximal of the hook 36, when the plunger 32 is in the secondadvanced position. The distal end 38 of the suture thread 24 can beextend out the suture device 20 when the plunger 32 is in the secondadvanced position. For instance, the suture thread 24 can extend distalwith respect to the sleeve, and can further extend distal with respectto the cannulated hook 36, for instance when the suture device 20includes the cannulated hook 36. The distal end 38 of the suture thread24 can then be picked up with any suitable instrument, such as a clamp,to complete the suturing procedure. For instance, the instrument cangrasp the suture thread 24 and place the suture thread in sufficienttension that causes the suture thread 24 to be dislodged from the clamp34 and free the suture thread 24 for further distal translation withrespect to the suture device 20.

In embodiments where the sleeve 22 is connected to the hook 36, the hook36 can be driven and guided into soft tissue of the patient's body wheninserting the device 20 the body. Thus when the hook 36 is in a desiredlocation, the plunger 32 can eject the distal end 38 of the suturethread 24 distally out the hook 36. In embodiments where the suturedevice 20 does not include the hook 36, for instance when inserting thesuture thread 24 to an anatomical location that defines an anatomicallynatural void, the distal end 38 of the suture thread can be picked upwith any suitable instrument once the distal end 38 extends distal withrespect to the sleeve 22.

In accordance with one embodiment, a tissue repair kit can include atleast one sleeve 22, at least one handle 46 that is connected orconfigured to be connected to the proximal end of the sleeve 22, atleast one plunger 32, and at least one hook 36 that is connected orconfigured to be connected to the sleeve 22. For instance, the kit caninclude a plurality of differently shaped hooks 36. The different shapescan include one or more curves in a common plane or in multiple planes,and/or can further include differently shaped tips, e.g. straight/bentto the right/bent to the left so that the device can be adapted to aparticular use. In instances where the hook 36 is connected to thesleeve 22 as manufactured, the sleeve 22 can be coupled to the handle 46as desired. The kit can further include a plurality of suture threads24, each having different diameters that are configured to be releasablyfixed to the suture device 20, and in particular the plunger 32.

Although the invention and its advantages have been described in detail,it should be understood that various changes, substitutions, andalterations can be made herein without departing from the spirit andscope of the invention as defined by the appended claims. Moreover, thescope of the present application is not intended to be limited to theparticular embodiments described herein. Furthermore, it should beappreciated that apparatus and methods described in connection with oneembodiment can be equally applicable to all other embodiments unlessotherwise indicated. One of ordinary skill in the art will readilyappreciate from the present disclosure that apparatus and methodspresently existing or later to be developed that perform substantiallythe same function or achieve substantially the same result as thecorresponding embodiments described herein may be utilized according tothe present invention. Thus, it will be appreciated by those skilled inthe art that various modifications and alterations of the invention canbe made without departing from the broad scope of the appended claims.Some of these have been discussed above and others will be apparent tothose skilled in the art.

What is claimed is:
 1. A suture device configured to guide a suturethread, the suture device comprising: a sleeve including a sleeve bodythat defines a proximal end, a distal end spaced from the proximal endalong a central axis in a distal direction, and a sleeve length thatextends from the proximal end to the distal end, the sleeve defining anopening extending along the central axis between the proximal end andthe distal end; and a plunger including a plunger body that extendsalong the central axis when the plunger is disposed in the opening ofthe sleeve, the plunger body defining a plunger proximal end, a plungerdistal end spaced from the plunger proximal end along the central axis,and a plunger length that extends from the plunger proximal end to theplunger distal end, the plunger length being greater than the sleevelength, the plunger body defining a channel that extends from theplunger body proximal end to the plunger body distal end, wherein theplunger defines a clamp, the clamp including a pair of surfaces that areconfigured to capture the suture thread so as to releasably attach thesuture thread to the plunger, and wherein when the plunger is slidablydisposed in the opening of the sleeve, the plunger is movable in thedistal direction from a first retracted position in which a distalportion of the suture thread is located in the suture device to a secondadvanced position in which the distal portion of the suture threadextends out of the suture device.
 2. The suture device according toclaim 1, wherein the pair of surfaces are opposed to each other so as todefine a gap therebetween, at least a portion of the gap sized less thana cross-sectional dimension of the suture thread such that the opposedsurfaces compress the suture thread when the suture thread is disposedin the gap.
 3. The suture device according to claim 2, wherein the pairof surfaces taper toward each other along a direction from a peripheryof the plunger body towards the central axis.
 4. The suture deviceaccording to claim 2, wherein the opposed surfaces are angularly offsetwith respect to each other at an angle of no greater than 50°.
 5. Thesuture device according to claim 4, wherein the angle is no less than20°.
 6. The suture device according to claim 2, wherein the opposedsurfaces taper away from each other along a direction from a peripheryof the plunger body towards the central axis.
 7. The suture deviceaccording to claim 2, wherein the clamp is elastically configured sothat the suture thread is clipped into the plunger.
 8. The suture deviceaccording to claim 1, wherein the clamp comprises a narrowed section ofthe channel.
 9. The suture device according to claim 1, furthercomprising a cannulated hook that extends distal with respect to thesleeve and is configured to receive the suture thread from the openingof the sleeve.
 10. The suture device according to claim 9, wherein thecannulated hook is acuminate.
 11. The suture device according to claim9, wherein the cannulated hook is curved in more than one plane.
 12. Thesuture device according to claim 1, further comprising a handle thatdefines an aperture aligned with the opening of the sleeve when thehandle is attached to the sleeve.
 13. The suture device according toclaim 12, further comprising a slider attached to the plunger, theslider having a greater diameter than the plunger, wherein the slider isslidably disposed in the aperture of the handle.
 14. The suture deviceaccording to claim 13, wherein the handle defines a neck that dividesthe aperture into a proximal channel and a distal channel, and the neckdefines an abutment surface that is configured to abut the slider whenthe plunger is in the second advanced position.
 15. The suture deviceaccording to claim 13, further comprising a pushbutton attached to theslider.
 16. The suture device according to claim 1, further comprisingthe suture thread.
 17. The suture device according to claim 1, whereinthe suture thread is one of a multifilament or braided structure. 18.The suture device according to claim 1, wherein the channel extends froma periphery of the plunger body along a direction toward the centralaxis.
 19. The suture device according to claim 1, wherein the plunger isconfigured to be inserted through the proximal end of the sleeve intothe opening.
 20. The suture device according to claim 1, whereinmovement of the plunger from the first retracted position to the secondadvanced position does not cause the clamp to release the suture thread.21. The suture device according to claim 1, wherein the suture extendsout of a proximal end of the suture device in a proximal direcion thatis oppisite to the distal direction when the suture is attached to theclamp.
 22. A suture device configured to guide a suture thread, thesuture device comprising: a sleeve including a sleeve body that definesa proximal end and a distal end spaced from the proximal end along acentral axis in a distal direction, the sleeve defining an openingextending along the central axis between the proximal end and the distalend; a cannulated hook extending from the sleeve in the distaldirection; and a plunger configured to attach a portion of the suturethread, the plunger configured to be slidably disposed in the opening ofthe sleeve and movable in the distal direction along the central axisfrom a first retracted position in which the plunger and the portion ofthe suture thread are spaced from the cannulated hook to a secondadvanced position whereby the plunger and the portion of the suturethread extend into the cannulated hook.
 23. The suture device accordingto claim 22, wherein a distal portion of the suture thread is spacedfrom the portion of the suture thread along the distal direction, andthe distal portion of the suture thread extends out of the suture devicewhen the suture thread is attached to the plunger and the plunger is inthe second advanced position.
 24. The suture device according to claim23, wherein the distal portion of the suture thread is disposed in thedevice when the plunger is disposed in the first retracted position. 25.The suture device according to claim 22, wherein the plunger comprises aplunger body that extends along the central axis when the plunger isdisposed in the opening of the sleeve, wherein the plunger defines aclamp, the clamp including a pair of opposed surfaces that areconfigured to capture the portion of the suture thread so as toreleasably attach the suture thread to the plunger.
 26. The suturedevice according to claim 25, wherein the pair of opposed surfacesdefine a gap therebetween, at least a portion of the gap sized less thana cross-sectional dimension of the suture thread such that the opposedsurfaces compress the portion of the suture thread when the suturethread is disposed in the gap.
 27. The suture device according to claim26, wherein the opposed surfaces taper toward each other along adirection from a periphery of the plunger body towards the central axis.28. The suture device according to claim 26, wherein the opposedsurfaces taper away from each other along the direction from a peripheryof the plunger body towards the central axis.
 29. The suture deviceaccording to claim 26, wherein the clamp is elastically configured sothat the suture thread is clipped into the plunger.
 30. The suturedevice according to claim 25, wherein the opposed surfaces are angularlyoffset with respect to each other at an angle of no greater than 50°.31. The suture device according to claim 30, wherein the angle is noless than 20°.
 32. The suture device according to claim 25, wherein theplunger body defines a distal end and a proximal end, wherein theplunger defines a channel that extends through the plunger body from theproximal end to the distal end.
 33. The suture device according to claim32, wherein the clamp comprises a narrowed section of the channel. 34.The suture device according to claim 25, wherein the channel extendsfrom a periphery of the plunger body along a direction toward thecentral axis.
 35. The suture device according to claim 25, wherein thesuture extends out of a proximal end of the suture device in a proximaldirecion that is oppisite the distal direction when the suture isattached to the plunger.
 36. The suture device according to claim 22,wherein the cannulated hook is acuminate.
 37. The suture deviceaccording to claim 36, wherein the cannulated hook is curved in morethan one plane.
 38. The suture device according to claim 22, furthercomprising a handle that defines an aperture aligned with the opening ofthe sleeve when the handle is attached to the sleeve.
 39. The suturedevice according to claim 38, further comprising a slider attached tothe plunger, the slider having a greater diameter than the plunger,wherein the slider is slidably disposed in the aperture of the handle.40. The suture device according to claim 39, wherein the handle definesa neck that divides the aperture into a proximal channel and a distalchannel, and the neck defines an abutment surface that is configured toabut the slider when the plunger is in the second advanced position. 41.The suture device according to claim 39, further comprising a pushbuttonattached to the slider.
 42. The suture device according to claim 22,further comprising the suture thread.
 43. The suture device according toclaim 42, wherein the suture thread is one of a multifilament or braidedstructure.
 44. The suture device according to claim 22, wherein movementof the plunger from the first retracted position to the second advancedposition does not cause the plunger to release the suture thread.